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Iran

Iran - US Consular Information Sheet
July 1, 2008
COUNTRY DESCRIPTION:
Iran is a constitutional Islamic republic with a theocratic system of government where ultimate political authority is vested in a religious scholar, the Supreme Leader

Shia Islam is the official religion of Iran, and Islamic law is the basis of the authority of the state.
The Iranian Constitution guarantees freedom of worship to Jews, Christians and Zoroastrians, though they are sometimes the subject of discrimination and repression.
The workweek in Iran is Saturday through Thursday; however, many government offices and private companies are closed on Thursdays.
Friday is the day of rest when all establishments are closed.
Offices in Iran are generally open to the public during the morning hours only.
Read the Department of State Background Notes on Iran for additional information.
ENTRY/EXIT REQUIREMENTS:
Should you decide to travel to Iran despite the current Travel Warning, a passport and visa are required, except for travel to Kish Island.
To obtain a visa, contact the Iranian Interests Section of the Embassy of Pakistan located at 2209 Wisconsin Avenue NW, Washington, DC
20007; tel. 202-965-4990, 91, 92, 93, 94, 99, fax 202-965-1073, 202-965-4990 (Automated Fax-On-Demand after office hours).
Their web site is http://www.daftar.org/Eng/default.asp?lang=eng.

U.S. citizens traveling to Iran are being fingerprinted upon entry.
The Iranian press has reported that foreign tourists may obtain seven-day tourist visas at the airport in Tehran.
However, U.S. citizens are not eligible to receive these visas and have to obtain valid visas from the Iranian Interests Section in Washington.
Note:
possession of a valid Iranian visa will not guarantee entry into the country.
Some American travelers with valid visas have been refused entry at the border without explanation.
U.S. citizens do not have to obtain a visa for travel from Dubai, United Arab Emirates, to Kish Island.
U.S. passports are valid for travel to Iran.
However, the Iranian government does not recognize dual nationality and will treat U.S.-Iranian dual nationals solely as Iranian citizens.
Thus, U.S. citizens who were born in Iran, who became naturalized citizens of Iran (e.g. through marriage to an Iranian citizen), and children of such persons—even those without Iranian passports who do not consider themselves Iranian—are considered Iranian nationals by Iranian authorities.
Therefore, despite the fact that these individuals hold U.S. citizenship, under Iranian law, they must enter and exit Iran on an Iranian passport, unless the Iranian government has recognized a formal renunciation or loss of Iranian citizenship.
Dual nationals may be subject to harsher legal treatment than a visitor with only American citizenship.
(See section on Special Circumstances below.)
In the past, U.S.-Iranian dual nationals have been denied permission to enter/depart Iran using their U.S. passport; they have also had their U.S. passports confiscated upon arrival or departure.
(Depending on the circumstances, the individuals were sometimes able to retrieve their U.S. passports after renouncing their Iranian citizenship.)
Recently, Iranian authorities have prevented a number of Iranian-American citizen academics, journalists, and others who traveled to Iran for personal reasons from leaving, and in some cases have detained and imprisoned them on various charges, including espionage and being a threat to the regime.
Americans of Iranian origin should consider the risk of being targeted by authorities before planning travel to Iran.
Iranian authorities may deny dual nationals’ access to the United States Interests Section in Tehran, because they are considered to be solely Iranian citizens.

As a precaution, however, it is advisable for U.S.-Iranian dual nationals to obtain in their Iranian passports the necessary visas for the country which they will transit upon their return to the U.S. so that, if their U.S. passports are confiscated in Iran, they may depart Iran with their Iranian passport.
These individuals can then apply for a new U.S. passport in that third country.

Dual nationals whose U.S. passports are confiscated may also obtain a “Confirmation of Nationality” from the U.S. Interests Section of the Embassy of Switzerland, which is the U.S. protecting power.
This statement, addressed to the relevant foreign embassies in Tehran, enables the travelers to apply for third-country visas in Tehran.
Dual nationals finding themselves in this situation should note in advance that the Swiss Embassy would issue this statement only after the traveler's U.S. nationality is confirmed and after some processing delay.
Dual nationals must enter and depart the United States on U.S. passports.

Visa extensions are time-consuming and must be filed at least one week in advance of the expiration date.
As of March 21, 2006, a foreign national and anyone accompanying him/her will pay a fine of 300,000 rials or 30,000 ottomans per day for each day of unauthorized stay in Iran.

All Iranian nationals, including U.S.-Iranian dual nationals, must have an exit permit stamped in their Iranian passports in order to depart Iran.
The stamp is affixed to the Iranian passport when it is issued and remains valid until the expiration date of the passport.
All Iranian nationals residing abroad and in Iran, including U.S.-Iranian dual nationals, are now required to pay an exit tax regardless of the duration of their stay in Iran.
More specific information on Iranian passport and exit visa requirements may be obtained from the Iranian Interests Section of the Embassy of Pakistan in Washington, D.C.
Non-Iranian-national women who marry Iranian citizens gain Iranian nationality upon marriage.
If the marriage takes place in Iran, the woman’s American passport will be confiscated by Iranian authorities.
They must have the consent of their husbands to leave Iran or, in his absence, must gain the permission of the local prosecutor.
Iranian law combined with the lack of diplomatic relations between the United States and Iran means that the U.S. Interests Section in Tehran can provide only very limited assistance if an American woman married to an Iranian man has marital difficulties and/or encounters difficulty in leaving Iran.

After divorce or death of the husband, a foreign-born woman has the choice to renounce her Iranian citizenship but any of the couple’s children will automatically be Iranian citizens and their citizenship is irrevocable.
They will be required to enter and depart Iran on Iranian passports.
For a divorce to be recognized it should be carried out in Iran or, if outside Iran, in accordance with Sharia law.
Upon divorce, custody of the children normally goes to the mother until the child reaches age 7, at which point custody is automatically transferred to the father.
However, if the courts determine that the father is unsuitable to raise the children, they may grant custody to the paternal grandfather or to the mother, if the mother has not renounced her Iranian citizenship and is normally resident in Iran.
If the courts grant custody to the mother, she will need permission from the paternal grandfather or the courts to obtain exit visas for the minor children (under age 18) to leave the country.
Iran is not a signatory to the Hague Convention on the Civil Aspects of International Child Abduction.
Please see the Department of State’s International Parental Child Abduction flyer on Iran for further information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
U.S. citizens who travel to Iran despite the Travel Warning should exercise caution throughout the country, but especially in the southeastern region where westerners have been victims of criminal gangs often involved in the smuggling of drugs and other contraband.
American citizens should avoid travel to areas within 100 kilometers of the border with Afghanistan, within 10 kilometers of the border with Iraq, and generally anywhere east of the line from Bam and Bandar Abbas toward the Pakistan border.

Terrorist explosions have killed a number of people since 2005.
Be aware that the Iranian government has blamed the U.S. and/or UK governments for involvement in the February 2007 bombing that killed Iranian military forces in Zahedan in the southeast and the 2005/2006 bombings in Ahvaz/Khuzestan in the southwest.
A number of British firms were damaged in attacks in August and November 2005.

U.S. citizens are advised to avoid demonstrations and large public gatherings.
Increased tension between Iran and the West over the past several years is a cause of concern for American travelers.

Iranian security personnel may at times place foreign visitors under surveillance.
Hotel rooms, telephones and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Photography near military and other government installations is strictly prohibited and could result in serious criminal charges, including espionage, which carries the death penalty.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, including the Travel Warning for Uzbekistan and the Worldwide Caution can be found.

Up-to-date information on safety and security, including safety and security in Iran, can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or, for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Major crime is generally not a problem for travelers in Iran, although foreigners occasionally have been victims of petty street crime.
Young men in unmarked cars have robbed foreigners and young men on motor bikes have snatched bags.
There have been reports of robberies by police impersonators, usually in civilian clothing.
Insist on seeing the officer’s identity card and request the presence of a uniformed officer/marked patrol car.
Travelers should not surrender any documents or cash.

Travelers should not carry large amounts of hard currency.
In view of the possibility of theft, passports, disembarkation cards, other important documents and valuables should be kept in hotel safes or other secure locations.
Pre-booked taxis are safer than those hailed from the street.
Americans should check with their hotel or tour guide for information on local scams.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the U.S. Interests Section at the Swiss Embassy in Tehran or the nearest U.S. Embassy or Consulate.
Because of the lack of a U.S. Embassy in Iran, the processing time for a replacement passport takes longer at the U.S. Interests Section at the Swiss Embassy than elsewhere.

If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Interests Section for assistance.
The staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, Swiss Embassy officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent of the “911” emergency line in Iran is as follows:
115 for ambulance service, 125 for fire and 110 for police.
English speakers, however, are generally unavailable. See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Basic medical care and medicines are available in the principal cities, but may not be available in rural areas.
Medical facilities do not meet U.S. standards and sometimes lack medicines and supplies.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
In 2006, there were reports of Crimean Congo Hemorrhagic Fever, mostly in the southeastern Sistan va Baluchistan province.
See www.who.int/mediacentre/factsheets/fs208/en for more information.
Iranian authorities have confirmed outbreaks of avian influenza (bird flu) in January 2008 in northern Iran, as well as earlier reports among wild swans in the Anzali Wetlands and in domestic poultry in the northern provinces of Azerbaijan and Gilan.
There have been a number of fatalities from avian flu reported in eastern Turkey, 45 kilometers from the Iranian border.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Iran is provided for general reference only, and may not be totally accurate in a particular location or circumstance:
Travelers in possession of International Driver’s Permits may drive in Iran, though the U.S. Interests Section in Iran does not recommend that tourists drive in Iran.
Iran has a very high rate of traffic accidents, the second highest cause of mortality in the country.
Drivers throughout Iran tend to ignore traffic lights, traffic signs and lane markers.
Urban streets are not well lit.
It is therefore particularly dangerous to drive at night.
Sidewalks in urban areas only exist on main roads and are usually obstructed by parked cars.
In the residential areas, few sidewalks exist.
Drivers almost never yield to pedestrians at crosswalks.
If you are involved in an accident, no matter how minor, do not leave the scene.
Wait until the police arrive to file a report.

Iranian authorities sometimes set up informal roadblocks, both in cities and on highways, often manned by young, inexperienced officers.
They are often suspicious of foreigners.
Ensure you carry a form of identification with you and avoid getting into disputes.
Pollution levels from cars are very high, particularly in Tehran, which can trigger respiratory problems. Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the U.S. by carriers registered in Iran, the U.S. Federal Aviation Administration (FAA) has not assessed the Government of Iran’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Civil aviation in Iran continues to experience air incidents and accidents, including five crashes with fatalities between April 20, 2005, and November 27, 2006.
Incidents have included engine failure and planes veering off the runway.

SPECIAL CIRCUMSTANCES:
The Iranian Government has seized the passports and blocked the departure of foreigners who work in Iran on tax/commercial disputes.

In addition to being subject to all Iranian laws, U.S. citizens who also possess Iranian citizenship may also be subject to other laws that impose special obligations on citizens of Iran, such as military service or taxes. Iranian-citizen males aged 18-34 are required to perform military service, unless exempt.
Iranian-Americans, even those born in the U.S., are included.

Dual nationals sometimes have their U.S. passports confiscated and may be denied permission to leave Iran, or encounter other problems with Iranian authorities.
Likewise, Iranian authorities may deny dual nationals’ access to the U.S. Interests Section in Tehran, because they are considered to be solely Iranian citizens.
Refer to the above section entitled "Entry/Exit Requirements" for additional information concerning dual nationality.

U.S. citizens who are not dual U.S.-Iran nationals are encouraged to carry a copy of their U.S. passport (biodata page and page with Iranian visa) with them at all times, so that if questioned by local officials, proof of U.S. citizenship is readily available.
Carry some other form of identification with you, such as a drivers license or other photo identification at all times as well.
Credit cards and bank cards are not widely accepted in Iran.
It is difficult to change dollars to rials in Iranian banks and you may not be able to access your U.S. bank accounts via the Internet from Iran.
You will not be able to access your U.S. bank accounts using ATMs in Iran.
Travelers checks can be difficult to exchange.
Bring enough hard currency to cover your stay, but make sure you declare this currency upon entry.
There is no Western Union or similar institution and bank transfers may not be possible.
Exchange money only at banks or an authorized currency exchange facility, not on the street, and keep your exchange receipts.

Pre-paid overseas calling cards are available at most newsagents.
The Internet is widely used in Iran.
There are Internet cafes in most hotels.
Usage may be monitored.

Do not work illegally.
You will be deported, fined and/or imprisoned.
You may also be prevented from entering the country again.
Islamic law is strictly enforced in Iran.
Alcohol is forbidden. Importation of pork products is banned.
Consult a guide book on Iran to determine how to dress and behave properly and respectfully.
Women should expect to wear a headscarf and jacket that covers the arms and upper body while in public.
There may be additional dress requirements at certain religious sites, e.g., women might need to put on a chador (which covers the whole body except the face) at some shrines.
During the holy month of Ramadan, you should in general observe the Muslim tradition of not eating, drinking or smoking in public from sunrise to sunset each day, though there are exemptions for foreign travelers who eat in hotel restaurants.
(See the Criminal Penalties section below for more information.)
In general, it is best to ask before taking photographs of people.
Hobbies like photography and those involving the use of binoculars (e.g., bird-watching) can be misunderstood and get you in trouble with security officials.
(See the Safety and Security section above for warnings on photography.)
For specific information regarding Iranian customs regulations, contact the Iranian Interests Section of the Embassy of Pakistan in Washington, DC.
Please see our Customs Information for U.S. regulations.
Most laptops are controlled items.
It is unlawful to bring controlled items into Iran, even on a temporary basis, unless specifically authorized by the Office of Foreign Assets Control (OFAC) in a manner consistent with the Iran-Iraq Arms Nonproliferation Act of 1992 and other relevant law.
U.S. Government economic sanctions still govern imports of Iranian-origin goods and services and exports to Iran.
Except for carpets and foodstuffs, and information or informational materials and gifts valued at $100 or less, the importation of Iranian-origin goods or services into the United States is prohibited.
The exportation or re-exportation of goods, technology or services directly or indirectly from the United States or by a U.S. person to Iran also is prohibited, except in the following cases: articles donated to relieve human suffering (such as food, clothing and medicine), gifts valued at $100 or less, licensed exports of agricultural commodities, medicine and medical devices, and trade in informational materials.
The Office of Foreign Assets Control (OFAC), Department of Treasury, provides guidance to the public on the interpretation of the current economic sanctions.
For further information, consult OFAC’s Compliance Programs Division, at 202-622-2490, visit the OFAC web site at http://www.treas.gov/offices/enforcement/ofac/, or obtain information via fax at 202-622-0077.
For information concerning licensing of exports, contact OFAC’s Licensing Division at:

Licensing Division
Office of Foreign Assets Control
U.S. Department of the Treasury
1500 Pennsylvania Avenue NW
Treasury Annex
Washington, DC 20220
Telephone (202) 622-2480; Fax (202) 622-1657

Iran is prone to earthquakes.
Many people have died in recent years, most notably in the city of Bam in 2003, killing 30,000.
In February 2005, an earthquake measuring 6.4 on the Richter scale struck Zarand in southeast Iran.
In March 2006, several earthquakes occurred in Restan province, western Iran, killing around 100 and injuring 1200.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Iranian laws, even unknowingly, may be expelled, arrested or imprisoned.
Fines, public floggings, and long prison terms are common.
Former Muslims who have converted to other religions, as well as persons who encourage Muslims to convert, are subject to arrest and possible execution.
Drinking, possession of alcoholic beverages and drugs, un-Islamic dress, as well as public displays of affection with a member of the opposite sex are considered to be crimes.
Relations between non-Muslim men and Muslim women are illegal.
Adultery, sex outside of marriage and gay sex are all illegal under Iranian law and carry the death penalty.
DVDs depicting sexual relations and magazines showing unveiled women are forbidden.
Penalties for possession, use, or trafficking in illegal drugs in Iran are severe and convicted offenders can expect long jail sentences and heavy fines.
Iran executes many people each year on drug-related charges.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

U.S. citizens in Iran who violate Iranian laws, including laws that are unfamiliar to Westerners (such as those regarding the proper wearing of apparel,) may face severe penalties.

The Iranian Government reportedly has the names of all individuals who filed claims against Iran at the Iran-U.S. Claims Tribunal at The Hague pursuant to the 1981 Algerian Accords.
In addition, the Iranian Government reportedly has compiled a list of the claimants who were awarded compensation in the Iran Claims Program administered by the Foreign Claims Settlement Commission.
The Iranian government is allegedly targeting award-holders who travel to Iran.
It is reported that upon some claimants' entry into Iran, Iranian authorities question them as to the status of payment of their respective awards with a view to recouping the award money.
It is also reported that the Iranian Government has threatened to prevent U.S. claimants who visit Iran from departing the country until they make arrangements to repay part or all of their award.
CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION/U.S. INTERESTS SECTION LOCATION:
There is no U.S. Embassy or Consulate in Iran.
The Embassy of Switzerland serves as the protecting power for U.S. interests in Iran.
The U.S. Interests Section at the Swiss Embassy is currently located at Afrika Avenue, West Farzan Street, no. 59, Tehran.
The telephone numbers for the U.S. Interests Section are (98) 021-8878-2964 and 98-021-8879-2364, fax 98-021-8877-3265, email: tie.vertretung@eda.admin.ch.
The workweek is Sunday through Thursday.
Public service hours are 8:00 a.m. – 12:00 noon.
The Interests Section does not issue U.S. visas or accept visa applications.
The limited consular services provided to U.S. citizens in Tehran include:
(a) registering U.S. citizens;
(b) answering inquiries concerning the welfare and whereabouts of U.S. citizens in Iran;
(c) rendering assistance in times of distress or physical danger;
(d) providing U.S. citizens with passport and Social Security card applications and other citizenship forms for approval at the U.S. Embassy in Bern, Switzerland;
(e) performing notarial services on the basis of accommodation; and,
(f) taking provisional custody of the personal effects of deceased U.S. citizens.
Americans living or traveling in Iran are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Iran.
They may also register on the web site of the U.S. Interests Section at www.eda.admin.ch/tehran.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate before flying to Iran.
By registering, American citizens make it easier for the U.S. Interests Section to contact them in case of emergency.
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This replaces the Consular Information Sheet dated June 5, 2007, to update the sections on Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances, Criminal Penalties and Registration/U.S. Interests Section Location.

Travel News Headlines WORLD NEWS

Date: Wed, 1 Apr 2020 12:33:43 +0200 (METDST)

Tehran, April 1, 2020 (AFP) - Flooding in Iran caused by heavy rainfall has left 21 people dead and one missing, an emergency services spokesman said Wednesday, even as the country battles the coronavirus pandemic.   Mojtaba Khaledi told Iran's ISNA news agency that 22 people had also been injured, with most of the casualties in southern or central provinces.   He said 11 people had died in Fars province, three each in Hormozgan and Qom, two in Sistan and Baluchistan province, and one each in Bushehr and Khuzestan.   Khaledi said one person was still missing in Hormozgan on the Gulf coast.

Flooding last week killed 12 people, and Khaledi warned of more heavy rain to come.   Iran is battling one of the world's deadliest coronavirus outbreaks with 3,036 deaths and 47,593 infections.   In March and April last year, heavy rainfall and flooding killed at least 76 people in Iran.   At the time, the International Federation of Red Cross and Red Crescent Societies estimated 10 million people were affected, describing the floods as "the largest disaster to hit Iran in more than 15 years".
Date: Sun 29 Mar 2020 11:46 AM GST
Source: Reuters [abridged, edited]

Iran's coronavirus death toll has risen to 2640, a health ministry official said on Sunday [29 Mar 2020], as the Middle East's worst-hit country grapples with the fast-spreading outbreak. "In the past 24 hours we had 123 deaths and 2901 people have been infected, bringing the total number of infected people to 38 309," Alireza Vahabzadeh, an adviser to the health minister, said in a tweet. "12,391 people infected from the virus have recovered." Health ministry spokesman Kianush Jahanpur told state TV that 3467 of those infected were in "critical condition".  "I am happy to announce that also 12,391 people who had been infected across the country have recovered," Jahanpur said. "The average age of those who have died of the disease is 69."

President Hassan Rouhani urged Iranians to adapt to their new way of life, which was likely to continue for some time. "We must prepare to live with the virus until a treatment is discovered ... The new measures that have been imposed are for everyone's benefit ... Our main priority is the safety and the health of our people," Rouhani said during a televised meeting.

The government has banned inter-city travel after warning of a potential surge in coronavirus cases because many Iranians defied calls to cancel travel plans for the Persian New Year holidays that began on [20 Mar 2020]. The authorities told Iranians to stay at home, while schools, universities, cultural, religious, and sports centres have been temporarily closed.

To stem the spread of the virus in crowded jails, Iran's judiciary on Sunday [29 Mar 2020] extended furloughs for 100,000 prisoners. On [17 Mar 2020], Iran said it had freed about 85,000 people from jail temporarily, including political prisoners. "The 2nd wave of (the) temporary release of prisoners had already started and their (100,000 prisoners) furloughs have been extended until [19 Apr 2020]," judiciary spokesman Gholamhossein Esmaili was reported as saying by state television. Iran said it had 189,500 people in prison, according to a report submitted by the UN special rapporteur on human rights in Iran to the Human Rights Council in January [2020].  [byline: Parisa Hafezi]
===================
[In the 24 hours from 28 to 29 Mar 2020, the number of cases of COVID-19 confirmed in Iran grew from 35 408 to, 38 309, an increase of 2901 newly confirmed cases. The number of deaths has also increased from 2517 to 2640 an increase of 123 deaths in the 24-hour period. In terms of total numbers of confirmed cases, Iran ranks 7th globally behind USA, Italy, China, Spain, Germany and France. In early March 2020, Iran and Italy were on the same trajectory with respect to daily growth in cumulative newly confirmed cases, but starting 8 Mar 2020, Italy's daily reported newly confirmed cases accelerated at an alarming speed. By 14 Mar 2020, Italy was reporting almost twice as many cases as Iran on a daily basis.

A map of Iran showing provinces can be seen at
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/128>. - ProMed Mod.MPP]
Date: Fri 27 Mar 2020
Source: AP News [edited]

Standing over the still body of an intubated 5-year-old boy wearing nothing but a plastic diaper, an Iranian healthcare worker in a hazmat suit and mask begged the public for just one thing: Stop drinking industrial alcohol [methanol, the most common industrial alcohol] over fears about the new coronavirus.

The boy, now blind after his parents gave him toxic methanol in the mistaken belief it protects against the virus, is just one of hundreds of victims of an epidemic inside the pandemic now gripping Iran.

Iranian media report nearly 300 people have been killed and more than 1000 sickened so far by ingesting methanol across the Islamic Republic, where drinking alcohol [ethanol] is banned and where those who do rely on bootleggers. An Iranian doctor helping the country's Health Ministry told the Associated Press on Friday [27 Mar 2020] the problem was even greater, giving a death toll of around 480 with 2850 people sickened. [Apparently all from methanol intoxication. - ProMed Mod.TG]

The poisonings come as fake remedies spread across social media in Iran, where people remain deeply suspicious of the government after it downplayed the crisis for days before it overwhelmed the country.

"Other countries have only one problem, which is the new coronavirus pandemic. But we are fighting on 2 fronts here," said Dr. Hossein Hassanian, an adviser to Iran's Health Ministry, who gave the higher figures to the AP. "We have to both cure the people with alcohol [methanol] poisoning and also fight the coronavirus."

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough, clearing up in 2-3 weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death.

The pandemic has swept across the world, overwhelming hospitals, crippling economies, and forcing governments to restrict the movements of billions of people. Particularly hard hit has been Iran, home to 80 million people.

As of now, there is no known cure for COVID-19, the illness caused by the virus. Scientists and doctors continue to study the virus and search for effective medicines and a vaccine.

But in messages forwarded and forwarded again, Iranian social media accounts in Farsi falsely suggested a British schoolteacher and others cured themselves of the coronavirus with whiskey and honey, based on a tabloid story from early February [2020]. Mixed with messages about the use of alcohol-based hand sanitizers, some wrongly believed drinking high-proof alcohol would kill the virus in their bodies.

The Islamic Republic has reported over 29 000 confirmed cases [of COVID-19] and more than 2200 deaths from the virus, the highest toll of any country in the Middle East. International experts also fear Iran may be under-reporting its cases, as officials for days played down the virus ahead of a parliamentary election.

That fear of the virus, coupled with poor education and internet rumours, saw dozens sickened by drinking bootleg alcohol containing methanol in Iran's southwestern Khuzestan province and its southern city of Shiraz. Videos aired by Iranian media showed patients with IVs stuck in their arms, lying on beds otherwise needed for the fight against the coronavirus, including the intubated 5-year-old boy. Iranian media also reported cases in the cities of Karaj and Yazd.

In Iran, the government mandates manufacturers of toxic methanol add an artificial color to their products so the public can tell it apart from ethanol, the kind used in cleaning wounds. Ethanol is also the kind of alcohol found in alcoholic beverages, though its production is illegal in Iran.

Some bootleggers in Iran use methanol, adding a splash of bleach to mask the added color before selling it as drinkable. Sometimes it is mixed with consumable alcohol to stretch supply, and other times it comes as methanol, falsely advertised as drinkable. Methanol also can contaminate traditionally fermented alcohol.

Methanol cannot be smelled or tasted in drinks. It causes delayed organ and brain damage. Symptoms include chest pain, nausea, hyperventilation, blindness, and even coma.

Hassanian said his figures included reports from coroner's offices around Iran also counting those who died outside of hospitals from the poisonings.

"Unfortunately, in some provinces, including Khuzestan and Fars, deaths from drinking methanol has exceeded the number of deaths from the new coronavirus," he said.

Dr. Knut Erik Hovda, a clinical toxicologist in Oslo, said to expect more methanol poisoning victims.

"The virus is spreading, and people are just dying off, and I think they are even less aware of the fact there are other dangers around," Hovda said. "When they keep drinking this [methanol], there's going to be more people poisoned."

Even before the outbreak, methanol poisoning had taken a toll in Iran. One academic study found methanol poisoning sickened 768 people in Iran between September and October 2018 alone, killing 76.

Other Muslim nations banning their citizens from drinking also see such methanol poisoning, although Iran appears to be the only one in the pandemic so far to turn toward it as a fake cure. In Buddhist Cambodia, police said they seized 4200 liters (1100 gallons) of methanol from a man who unwittingly planned to make toxic hand sanitizer because of the virus outbreak.

Muslim drinkers in Iran can be punished with cash fines and 80 lashes. However, minority Christians, Jews, and Zoroastrians can drink alcoholic beverages in private.

While police occasionally announce alcohol busts, the trade in nontoxic alcohol also continues. Locally made Iranian arak from fermented raisins, known as Aragh sagi, sells for USD 10 for a 1.5 l [1.6 qt] bottle. Imported vodka sells for USD 40 a bottle.

"Every year during Nowruz, or the Persian New Year holidays beginning 21 Mar 2020, my customers double," said Rafik, an Iranian-Armenian who makes vodka in the basement of his Tehran home. He spoke on the condition only his 1st name be used for fear of arrest. "This year [2020], because of coronavirus, it jumped up by 4- or 5-fold."

Farhad, a self-described heavy drinker who lives in central Tehran, said alcohol remains easy to find for those looking for it. "Even you can find it offered when you are walking down the street, " he said.

Since 1979, Iran's 40 alcohol factories have seen their production changed to pharmaceutical needs and sanitizers. Others had been left idle, like the abandoned Shams alcohol factory east of Tehran.

But now, in a time when even some mosques in Iran hand out high-proof alcohol as a sanitizer, officials plan to start work again at Shams to produce 22 000 l [23 247 qt] of 99% alcohol a day. [This alcohol is not for internal consumption but can be used in hand sanitizers. - ProMed Mod.TG]  [Byline: Nasser Karimi and Jon Gambrell]
====================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until sometime after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH [alcohol dehydrogenase], but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10% dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from

This tragic development is another example of the broader deleterious impact of a pandemic on other aspects of public health.  Anecdotal reports of other potentially harmful "home remedies" for COVID-19 being hawked on the internet reminds us that education of the general public and responsible messaging are more important now than ever. - ProMed Mod.LXL]

[HealthMap/ProMED-mail map:
Date: Sat, 14 Mar 2020 11:58:18 +0100 (MET)

Tehran, March 14, 2020 (AFP) - Iran said on Saturday that the novel coronavirus has claimed 97 more lives, raising the country's total to 611, as the number of confirmed cases jumped again.   Health ministry spokesman Kianoush Jahanpour said that "1,365 fresh cases have been added to the number of confirmed infections in the past 24 hours", bringing the total to 12,729.   Jahanpour told a televised news conference that more than 4,300 of those with confirmed infections had recovered so far.

Tehran province had the highest number of new cases with 347, followed by Isfahan with 155 and the northern region of Alborz with 134.   "Naturally, the number of confirmed cases will increase" even more as Iran steps up its laboratory sampling and tests, he said.   The outbreak in Iran is one of the deadliest outside of China, where the disease originated.
Date: Tue 3 Mar 2020 12:24 AM MYT
Source: The Star, Associated Press (AP) report [edited]

Iran put its armed forces on alert on Tuesday [3 Mar 2020] to assist health officials in battling the new coronavirus [SARS-CoV-2] that has killed at least 77 people, an outbreak that has sickened top officials and pushed even its supreme leader into wearing disposable gloves while trying to reassure the nation. Even as government officials sit metres away from each other at meetings now in an effort to stop its spread, the virus is ravaging both its civilian leadership and its Shiite theocracy. A top emergency official and at least 23 members of parliament reportedly contracted the virus and now suffer from the COVID-19 illness it causes. Others have died.

There are now over 2540 cases of the new virus across the Middle East, with 2336 in Iran alone. Of those outside Iran in the region, most link back to the Islamic Republic. Experts worry Iran's percentage of deaths to infections, now around 3.3%, is much higher than other countries, suggesting the number of infections in Iran may be far greater than current figures show.

Meanwhile, a gloved Ayatollah Ali Khamenei sought to minimise the virus while praising the doctors and nurses combating the outbreak. He urged the nation to pray. "This disaster, in our opinion, is not such a big disaster, there have been and there are bigger disasters than this," Khamenei said. "Of course I don't want to downplay the issue, but let's not exaggerate it much either. Something has happened, it will exist in the country for a time, which hopefully will be short, and then it will go away."

The death of Expediency Council member Mohammad Mirmohammadi on Monday [2 Mar 2020] makes him the highest-ranking official within Iran's leadership to be killed by the virus. State media referred to him as a confidant of Khamenei. The virus earlier killed Hadi Khosroshahi, Iran's former ambassador to the Vatican, as well as a recently elected member of parliament. Ahmad Tuyserkani, an adviser to Iran's judiciary chief, died on Monday night [2 Mar 2020] from the virus, semi-official media reported. Those sick include vice president Masoumeh Ebtekar, better known as "Sister Mary", the English-speaking spokeswoman for the students who seized the US Embassy in Teheran in 1979 and sparked the 444-day hostage crisis, state media reported. Also sick is Iraj Harirchi, the head of an Iranian government task force on the coronavirus who tried to downplay the virus before falling ill.

On Tuesday [3 Mar 2020], lawmaker Abdolreza Mesri told Iranian state television's Young Journalists Club programme that 23 members of parliament had the coronavirus. He urged all lawmakers to avoid the public. "These people have a close relationship with the people and they carry different viruses from different parts of the country, which may create a new virus, so we recommend the lawmakers to cut off their relationship with the public for now," Mesri said.

Members of Iran's Supreme Council of Economic Coordination, including president Hassan Rouhani, met on Tuesday [3 Mar 2020] and sat metres apart from each other. State media did not comment on the move, nor the fact the meeting appeared attended by fewer officials than normal. Iran's state-run IRNA news agency also reported that Pirhossein Koulivand, head of the country's emergency services, had come down with the new virus. It said he was undergoing treatment.

Khamenei ordered Iran's armed forces to be ready to help health workers, but it wasn't immediately clear what the order entailed. Officials previously said they had plans for 300,000 soldiers and members of the Basij, the all-volunteer force of Iran's Revolutionary Guard, to sanitize public areas, direct traffic and trace contacts that sick people had with others. The Guard also has been spraying down streets in major Iranian cities. "Whatever helps public health and prevents the spread of the disease is good and what helps to spread it is sin," Khamenei said at an annual tree-planting ceremony. He had never worn gloves at the ceremony in recent years.

However, life has slowed in Iran's capital, Tehran, where a perfume seller simply stood at her stand at an upscale mall with no one to offer samples. "People are afraid to touch anything or take anything from us," she said. "Everyone is at a loss."

Meanwhile on Tuesday [3 Mar 2020], the Middle East's largest airline, Emirates, said it had to reduce or ground flights due to the new virus. Because of the slowdown, the government-owned carrier has asked its employees to take paid and even unpaid leave for up to a month at a time. Emirates operates out of Dubai, the world's busiest for international travel. "We have been tested before and Emirates will come out stronger," chief operating officer Adel Al-Redha said.

The world's largest airline trade association, IATA, says Middle East carriers have already lost around USD 100 million in revenue due to a drop in ticket sales because of disruptions caused by the virus.
=======================
[In the past 24 hours, the number of cases of COVID-19 confirmed in Iran has grown from 1501 to 2336, an increase of 835 newly confirmed cases. The number of deaths has also increased from 66 to 77, an increase of 11 new deaths. The number of MPs (members of parliament) in the country who have been infected is curious, 23 out of 290 parliament members (7.9%).

Qom, the apparent epicenter of this outbreak, is located to the south west of Tehran in central Iran. Other media reports have mentioned that Tehran has become a major focus of cases.

A map of Iran showing provinces can be seen at
<https://www.mapsofworld.com/iran/iran-political-map.html> and a HealthMap/ProMED-mail map of Iran is available at
More ...

World Travel News Headlines

Date: Wed, 1 Apr 2020 14:43:58 +0200 (METDST)

Paris, April 1, 2020 (AFP) - A man has been jailed in France for repeatedly violating strict anti-coronavirus lockdown rules, which have seen 359,000 fines issued countrywide as the outbreak death toll continues to mount, authorities said Wednesday.    Police Minister Christophe Castaner warned residents to write off any travel plans for school holidays starting this weekend, promising to punish any unwarranted movement as the country continues to evacuate dozens of critically ill patients from hospitals in overstretched areas of the country.

The Ile-de-France region, with Paris at its core, saw its first evacuations Wednesday as the outbreak which started in the east of France takes an ever-heavier toll on the capital.   Twenty-four patients were sent from Paris to Brittany in northern France in the morning on a high-speed train, fully equipped as a hospital on tracks, with 12 others to follow on a second train later.

A third of the 499 deaths registered in France in the previous 24 hours had been from Ile-de-France, the government said, with the countrywide death toll now at 3,523.   Only deaths in hospital are counted towards the official tally, which excludes people who passed away in old age facilities or at home.   To date, the government has evacuated nearly 300 patients from hospitals in hard-hit areas of the country to lesser burdened ones, and some to Germany, Switzerland and Luxembourg. Austria said Wednesday it would take three patients from eastern France.

- 'We must stand strong' -
As the medical crisis escalates, a court in Calais in the country's north sentenced a 20-year-old man to two months in prison after he was caught eight times without the self-certified document all residents are required to show if they leave the house for critical business.   This can include essential shopping, going to the doctor, walking the dog, a quick jog, and going to work for those in critical fields.     In Paris on Tuesday, a court sentenced a 22-year-old man to 105 hours of community service, also for repeatedly violating the lockdown.

Castaner said some 5.8 million checks have been carried out and 359,000 fines issued since the lockdown started on March 17, and stressed that leaving on holiday was not allowed under the lockdown rules that have confined millions of children at home with schools closed.   Even with train and plane traffic slashed to a minimum, authorities fear a holiday exodus and the minister said controls will be stepped up on the roads and at train stations and airports.   "Confinement is a strain for families, I know, but we must stand strong," he said.   More than 22,700 people are hospitalised for COVID-19 in France, with 5,565 in intensive care.
Date: Wed, 1 Apr 2020 12:33:43 +0200 (METDST)

Tehran, April 1, 2020 (AFP) - Flooding in Iran caused by heavy rainfall has left 21 people dead and one missing, an emergency services spokesman said Wednesday, even as the country battles the coronavirus pandemic.   Mojtaba Khaledi told Iran's ISNA news agency that 22 people had also been injured, with most of the casualties in southern or central provinces.   He said 11 people had died in Fars province, three each in Hormozgan and Qom, two in Sistan and Baluchistan province, and one each in Bushehr and Khuzestan.   Khaledi said one person was still missing in Hormozgan on the Gulf coast.

Flooding last week killed 12 people, and Khaledi warned of more heavy rain to come.   Iran is battling one of the world's deadliest coronavirus outbreaks with 3,036 deaths and 47,593 infections.   In March and April last year, heavy rainfall and flooding killed at least 76 people in Iran.   At the time, the International Federation of Red Cross and Red Crescent Societies estimated 10 million people were affected, describing the floods as "the largest disaster to hit Iran in more than 15 years".
Date: Wed, 1 Apr 2020 10:00:47 +0200 (METDST)

Sydney, April 1, 2020 (AFP) - Australian health officials set up a coronavirus testing clinic on Sydney's Bondi Beach Wednesday, as concern grew that COVID-19 was spreading among backpackers in the popular tourist destination.   More than 100 cases of coronavirus have reportedly been identified in the area -- many linked to two massive club parties held in mid-March before the country shut down bars, pubs and other non-essential services.   Photos shared online last week also showed mostly young beachgoers packed together on the sand after outdoor gatherings were curtailed, drawing howls of protest.

That led to sunbathers, surfers and tourists being banned from the beach, with police enforcing the prohibition.   New South Wales Health said the Waverley Council area, which encompasses Bondi, had the highest number of confirmed cases in Sydney.   "A plausible explanation is they have come in contact with an infected backpacker before that backpacker was aware they had COVID-19," said chief health officer Kerry Chant.   Australia has recorded almost 5,000 coronavirus infections and 20 deaths, with almost half of those in New South Wales.
Date: Wed, 1 Apr 2020 00:15:13 +0200 (METDST)

London, March 31, 2020 (AFP) - A 13-year-old British boy has died days after testing positive for COVID-19, hospital officials and his family said on Tuesday, with relatives saying he had no underlying illnesses.   The boy, who died Monday at King's College Hospital in London, is believed to be Britain's youngest confirmed death in the coronavirus pandemic.

A 12-year-old girl, whose death was confirmed earlier on Tuesday in Belgium, is thought to be Europe's youngest victim.    The boy's family said Ismail Mohamed Abdulwahab "started showing symptoms and had difficulties breathing" before he was admitted to hospital.   "He was put on a ventilator and then put into an induced coma but sadly died yesterday morning," the family said through a family friend, Mark Stephenson, adding: "We are beyond devastated."

Nathalie MacDermott, a lecturer at King's College, said: "While we know it is much less likely for children to suffer severe COVID-19 infection than older adults, this case highlights the importance of us all taking the precautions we can to reduce the spread of infection in the UK and worldwide."   She urged research into deaths outside the groups expected to succumb to infection as it "may indicate an underlying genetic susceptibility."

On Tuesday, Britain announced 381 deaths from COVID-19 in the past 24 hours, the highest figure in the country since the start of the pandemic, bringing the death toll to 1,789.
Date: Tue 31 Mar 2020 4:36 PM PDT
Source: San Francisco Chronicle [abridged, edited]

The captain of a nuclear aircraft carrier with more than 100 sailors infected with the coronavirus pleaded Monday [30 Mar 2020] with US Navy officials for resources to allow isolation of his entire crew and avoid possible deaths in a situation he described as quickly deteriorating.

The unusual plea from Captain Brett Crozier, a Santa Rosa native, came in a letter obtained exclusively by The Chronicle and confirmed by a senior officer on board the aircraft carrier Theodore Roosevelt, which has been docked in Guam following a COVID-19 outbreak among the crew of more than 4000 less than a week ago. "This will require a political solution but it is the right thing to do," Crozier wrote. "We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset -- our sailors." In the 4-page letter to senior military officials, Crozier said only a small contingent of infected sailors have been off-boarded. Most of the crew remain aboard the ship, where following official guidelines for 14-day quarantines and social distancing is impossible. "Due to a warship's inherent limitations of space, we are not doing this," Crozier wrote. "The spread of the disease is ongoing and accelerating." He asked for "compliant quarantine rooms" on shore in Guam for his entire crew "as soon as possible."

"Removing the majority of personnel from a deployed US nuclear aircraft carrier and isolating them for 2 weeks may seem like an extraordinary measure. ... This is a necessary risk," Crozier wrote. "Keeping over 4000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care."

Acting Navy Secretary Thomas Modly spoke to CNN. "I heard about the letter from Capt Crozier (Tuesday) morning [31 Mar 2020], I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn't have enough beds right now and we're having to talk to the government there to see if we can get some hotel space, create tent-type facilities," Modly said.

"We don't disagree with the (captain) on that ship and we're doing it in a very methodical way because it's not the same as a cruise ship, that ship has armaments on it, it has aircraft on it, we have to be able to fight fires if there are fires on board the ship, we have to run a nuclear power plant, so there's a lot of things that we have to do on that ship that make it a little bit different and unique but we're managing it and we're working through it," he said.

So far, none of the infected sailors has shown serious symptoms, but the number of those who have tested positive has jumped exponentially since the Navy reported infections in 3 crew members on [24 Mar 2020], the 1st time COVID-19 infections had been detected on a naval vessel at sea.

Retired Admiral James Stavridis, former NATO Supreme Allied Commander Europe, told The Chronicle Tuesday [31 Mar 2020] in an email that "we should expect more such incidents because warships are a perfect breeding ground for coronavirus." "Unfortunately, naval vessels are ideal breeding grounds for the spread of viruses because it is impossible to do social distancing on one" because of the tight quarters on board, Stavridis said. The ship's problems will "compound", Stavridis said, because you can't tie the vessel up "and send everyone ashore. It is full of weapons, billions of dollars of equipment, fire hazards, and nuclear reactors".

Scrubbing the Theodore Roosevelt of the virus will not be complicated, but "time-consuming", he said. He estimated cleaning would take 5 to 10 days with a crew of 350 people. Senior military officials said last week that the entire crew of more than 4000 will be tested. The carrier's home port is San Diego.

At the time, Modly expressed confidence that they identified all the sailors who had been in contact with the trio of infected sailors and they had been quarantined. "This is an example of how we are able to keep our ships deployed at seas and underway, even with active COVID-19 cases," Modly said. But by the time the ship reached port in Guam on Friday [27 Mar 2020], the number of cases had grown to 25, and soon after to 36, according to reports.

But by Monday [30 Mar 2020], a senior officer on board the massive aircraft carrier, who wished to remain anonymous because they are not authorized to speak to the media, said between 150 and 200 sailors had tested positive. None had been hospitalized -- yet, the source said. The Chronicle agreed to withhold the officer's name based on its anonymous sources policy.

Gilday told reporters last week [week of 23 Mar 2020] it was unclear if sailors became infected following the ship's previous port of call in early March [2020] to Da Nang, Vietnam. Gilday said they debated whether to go on with the Viet Nam visit, but at the time there were only 16 coronavirus cases in northern Viet Nam and the port was in the central part of the country. Sailors were screened prior to returning on board. The 1st 3 sailors tested positive 15 days after leaving Vietnam, officials said.

The virus has been hard to contain on board ever since. Federal and military guidelines recommend individual quarantine, including no use of common areas. "Due to the close quarters required on a warship and the current number of positive cases, every single sailor, regardless of rank, on board the TR [Theodore Roosevelt] must be considered 'close contact,'" Crozier wrote. The tight quarters on the carrier are "most conducive to spread", he wrote, including large amounts of sailors in a confined space, shared sleeping quarters, restrooms, workspaces and computers, a common mess hall, meals cooked by exposed personnel, and movement constraints requiring communal contact with ladders and hatches.

The captain compared the situation to the Diamond Princess cruise ship, citing a study that focused on what could have happened to that cruise ship had no isolation been done. A total of 712 passengers eventually tested positive for COVID-19 from that cruise departing from Japan; however, the study found if there had been no early isolation close to 80% of passengers and crew would have been infected. And had the cruise line immediately evacuated the ship after the 1st positive tests, the study found only 76 people would have tested positive.

Of the 1st 33 Roosevelt sailors testing positive, 7, or 21%, originally tested negative. After testing negative, those 7 sailors presented symptoms within 1 to 3 days after their initial negative test, Crozier said. The testing should be utilized, the captain wrote, after a proper 14-day quarantine to ensure no infected sailors return on board a clean ship. As part of his plan, 10% of the crew would stay on board to run the reactor plant, sanitize the ship, ensure security and provide contingency response for emergencies.  [byline: Matthias Gafni Joe Garofoli]
==================
[It does seem as though ships in general are ideal incubators for this virus (the SARS-CoV-2). Cruise ships with cabins for 2-4 passengers have proven to be excellent captive audiences for the virus to spread (see prior post: COVID-19 update (60): global, cruise ships, lessons learned, WHO http://promedmail.org/post/20200329.7156949 for a recent summary of cruise ship related outbreaks as well as a series of posts from mid-February 2020 through the present
http://promedmail.org/post/20200215.6993525,
http://promedmail.org/post/20200328.7153651).

In addition to having people in close quarters even in "luxury liners" where maintaining a minimum of 6 feet (2 m) separation is virtually impossible, meals are often buffet style, with serving instruments shared by all. Imagine naval ships with more dormitory style quarters, perfect locations for rapid viral transmission. One can't help but wonder how many other naval vessels from multiple countries around the world are also experiencing similar outbreaks on their ships. - ProMed Mod.MPP]
Date: Thu 26 Mar 2020
Source: The News [edited]

At a time when health authorities are dealing with the threat of coronavirus in the country, cases of Crimean-Congo haemorrhagic fever (CCHF), which is a lethal viral disease, have started surfacing in Sindh, and 2 people have been diagnosed with the tickborne viral ailment within a week.

"Today, we had a 37 year old female patient from Tharparkar, who was bleeding from her nose and mouth. We sent her sample to the lab and the lab test confirmed that she is infected with Crimean-Congo haemorrhagic fever (CCHF)," said Dr Seemin Jamali, the executive director of the JPMC [Jinnah Postgraduate Medical Centre], while talking to The News on Wednesday [25 Mar 2020].

It is the 2nd case of the Congo fever in the current year [2020], she said, adding that earlier a 40 year old person from the Pak Colony of the city had been referred to the JPMC from the Civil Hospital Karachi, who tested positive for the CCHF. Dr Jamali maintained that the previous patient, who was a butcher by trade, had recovered and been discharged from the hospital, but the new patient, a woman from the Tharparkar district of Sindh, was under treatment and in a precarious condition.

Experts say Crimean-Congo haemorrhagic fever is a tickborne viral disease whose mortality rate is over 40 per cent, and it is mostly people who deal with livestock, including butchers and shepherds, who contract the disease after coming into contact with infected animals.
======================
[This is the 2nd case of CCHF from Karachi in 2020. The 1st case has already been reported in an earlier post. The CCHF cases in Pakistan show biannual peaks, between the months of March-May and August-October. Many factors, including poor sanitation, unhygienic transportation, and numerous animal slaughter sites, inefficient tick-control programs, post-slaughter piles of animal remains, nomadic lifestyle, and lack of general awareness contribute to the spread of CCHF.

Pakistan has confirmed cases of CCHF in almost every province: Sindh (Karachi), Punjab (Faisalabad, Multan, and Rawalpindi), Balochistan (Quetta) and Khyber Pakhtunkhwa (Peshawar). There is a need to educate the general public, farmers, and healthcare workers about the causes, transmission, and risks of CCHF and advise on practical preventive measures. - ProMed Mod.UBA]

[Maps of Pakistan:
Date: Mon 30 Mar 2020

There were 3 newly confirmed cases reported by Botswana with travel histories to the UK and Thailand. - ProMed Mod.MPP

HealthMap/ProMED-mail of Botswana:
Date: Mon 30 Mar 2020
Source: Zee News [edited]

A child died due to acute encephalitis syndrome (AES) in Bihar on Sunday (29 Mar 2020). "A child has lost his life due to acute encephalitis syndrome at Sri Krishna Medical College & Hospital (SKMCH) in Muzaffarpur," Dr SK Shahi, SKMCH superintendent said.

This is the 1st AES related death in the district this year [2020]. Last year [2019], over 140 children died due to AES in the district. As per official data, 121 deaths were reported at the government-run SKMCH, which handled the largest number of patients in the district, while 21 deaths were confirmed at the Kejriwal Hospital.

AES is a viral disease that causes flu-like symptoms such as high fever, vomiting, and, in extreme cases, brain dysfunction, seizure, and inflammation of the heart and kidney.
====================
[AES is a common ailment in children in north-eastern India, especially in Bihar state.

The issue of the aetiology of AES has been under discussion for a long time. AES has continued to be attributed to various aetiologies, including Reye syndrome-like disease, possible Japanese encephalitis, enterovirus infection from polluted water, heatstroke, intoxication from lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_).

A recent publication states that dengue virus is one of the 3 commonest agents identified in AES, but existing surveillance for AES does not include routine testing for dengue.

The above report does not indicate whether any of the above aetiologies have been ruled out or confirmed. Until the aetiology (or aetiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible. The season in which AES cases occur is just beginning, and additional cases can be expected over the coming 6-7 months. - ProMed Mod.TY]

[HealthMap/ProMED map available at:
Bihar State, India: <http://healthmap.org/promed/p/364>]
Date: Sat 28 Mar 2020
Source: CGTN Africa [edited]

The number of reported hepatitis E cases in Namibia are on the decrease, statistics released by the Ministry of Health on Saturday [28 Mar 2020] show. A total of 74 hepatitis E (HEV) cases were reported countrywide between 24 Feb and 8 Mar 2020, compared with 102 cases reported during the previous 2 weeks.

The Ministry of Health declared an outbreak of hepatitis E on 14 Dec 2017 in the capital, Windhoek. The outbreak then spread to other regions around April 2018, eventually involving a total of 10 regions. Cases have been reported mainly from informal settlements such as Havana and Goreangab in Windhoek, DRC [Democratic Resettlement Community] in Swakopmund and similar settings in other regions where access to potable water, sanitation, and hygiene is limited.

A total of 7457 hepatitis E cases have been reported since the outbreak began with 65 deaths reported nationally, representing a case fatality rate of 0.9 per cent.

"There is a decrease in the number of HEV cases during the reporting period. (However) the outbreak continues to be protracted and cases are still being detected in areas where water and toilet facilities are limited, particularly in Khomas and in Erongo regions," a report from the health ministry said.
=====================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMed Mod.LL]

[Maps of Namibia:
Date: Tue, 31 Mar 2020 22:17:01 +0200 (METDST)

Beirut, March 31, 2020 (AFP) - Lebanese authorities said Tuesday they would allow expatriates to return despite a lockdown in response to the coronavirus pandemic, a move that could affect up to 20,000 people.   The cabinet gave its initial approval for the proposal, which could be put in motion "in principle" from Sunday, a government statement said, without giving details of how it would be implemented.

An estimated 20,000 people "want to return to Lebanon", Foreign Minister Nassif Hitti told local television.  Beirut's international airport has been closed for nearly two weeks, along with schools, universities, restaurants and bars, and Lebanese have been urged to stay at home to stem the spread of COVID-19.   Lebanon has reported 463 official cases of the virus and 12 deaths.